Replacing Missing Teeth

Missing teeth can be replaced in a variety of ways.

You may be a candidate for any one or all of them, depending on the circumstances. Implants are becoming the treatment of choice for a number of reasons. Most significant among these is the expected longevity, strength and stability offered by current implant treatment, as well as the predictability of implant treatment with current technologies. Listed below are common treatment options for missing teeth.

Fixed Bridge
Teeth can also be replaced with a fixed bridge if there are teeth in the area that are adequate in number and sufficiently healthy and strong to support the artificial teeth. In order to fabricate a bridge, the adjacent teeth are prepared by reducing their size (or cut down) to remove all the enamel, making room for the prosthetic tooth restoration.
A prosthetic tooth (or teeth) can be suspended between adjacent teeth in this way to provide a functional and cosmetic replacement for the missing tooth.

The limitation of this form of treatment has to do with the irreversible preparation of the adjacent (abutment) teeth for support. This exposes them to the risk of trauma to their nerves, raising the risk of requiring root canal treatment. Long-term, fixed bridges between natural teeth have an average life expectancy of 10-12 years before requiring replacement. Replacement of fixed bridges often entails further treatment as the abutment or supporting teeth have been further compromised over time by advancing dental disease (such as cavities or periodontal bone loss).
Dentures
Removable partial or full dentures can replace a single missing tooth, several teeth, or all of the teeth in your upper and/or lower jaw. Dentures rely on support by the other teeth in that jaw (for partial dentures) and from mechanical support by the remaining ridge of gum and underlying bone. Maxillary (upper jaw) full dentures also may be helped by suction between the denture and the underlying gum of your palate (roof of mouth).

Reasons for replacing a missing tooth (or teeth) vary and should be weighed against the risks of leaving the space, as well as resultant changes that may take place in the rest of your dentition.

Bone Loss
When teeth are removed from the jaw, the bone that supports the teeth tends to shrink over time. This process is called resorption and is a natural consequence of the loss of stimulation to the bone from the forces placed on the teeth. Resorption of the alveolar bone (bone that supports the teeth) begins almost as soon as the tooth is removed and proceeds over time. The bone will lose both height and width from resorption.

When multiple teeth are lost, with or without a prosthesis to replace them, significant loss of jaw bone can take place. This sometimes leads to difficulty wearing a removable denture due to lack of an adequate "ridge" upon which the denture can obtain stability. In the so-called "esthetic zone" of the mouth, where loss of ridge volume can be visibly apparent to the naked eye, this can lead to a cosmetic defect. As the bone resorbs, the gum which covers it also shrinks away, creating a concavity (depression in height and width) that can be unsightly as well as possibly promote food impaction under adjacent teeth.

Drifting
Loss of one or two teeth in a segment of your mouth can lead to drifting of neighboring teeth, whereby the adjacent teeth lean over into the vacant space where the teeth have been lost.
Similarly, loss of a tooth or teeth can lead to shifting of opposing teeth as they drift down into the open space (super-erupt).

In general, our teeth have a constant tendency to move both towards the front of our mouths and towards the opposing jaw, unless they are stopped by something in their way, usually the adjacent or opposing teeth. Loss of teeth allows this to proceed in a pathologic way. As teeth drift, they create discrepancies in the height and contours of the gum tissue that predispose adjacent teeth to periodontal disease progression and/or dental decay from accumulation of food and plaque and difficulty in cleaning these areas from "piled-up" gum tissue. Drifting teeth can also adversely affect the occlusion (bite), as well as cosmetics of your face and smile.